Multidisciplinary teams are recognized as essential to effectiveness of DM programmes, another Panobinostat essential component of comprehensive care. Mechanisms for monitoring and reviewing both individual patients and programme strategies include: performance

and documentation of patient self-monitoring (an example for haemophilia could be review of bleeding records and product infusion responses at the time of consultation with a clinician), regular and as required communication, and engagement and education of local clinicians outside the HTC. Individualized treatment care plans are developed and agreed by the patient and clinicians. These will include product escalation protocols and advice on exercise and maintaining a healthy weight. Consistent with DM practice, serial

iterations of a patient’s treatment plan are informed by review of bleeding history, product infusion records and repeated physical and psychological YAP-TEAD Inhibitor 1 in vivo examinations using validated assessment tools for haemophilia (and other bleeding disorders, where available) [14,15]. Audit is best performed by external assessment. A ‘national service specification for haemophilia and other inherited bleeding disorders’ was published in the UK in 2001 with revision in 2006 [16]. This document includes recommendations and specifications for triennial audits of designated HTCs. The Triennial Audit Committee, in their 2011 report, advised that the next cycle of audits should take place in 2012. Audit teams are multidisciplinary and include patient members. They record in both template and free text format results of their review of many aspects of HTC service provision such as competence in laboratory (including genetic) testing, data collection and management, provision of and compliance

with approved treatment and dosing protocols, staffing levels, education and competency training and patients’ satisfaction and involvement in their care [16]. Other countries such as Canada are developing similar audit programmes [17]. Where external audit programmes do not exist, individual HTCs or a regional cluster of centres may set up internal audit programmes, using 上海皓元医药股份有限公司 the UK or other relevant models to benchmark their own processes and performance. A recent document on principles of comprehensive care in Europe highlights particular responsibilities of HTCs: to arrange for supply of safe clotting factor concentrates (CFCs) for use in home treatment and prophylaxis programmes (where possible), to contribute data to national registries and to record local treatment practice and outcomes, education, training and research – all of which can be audited given the appropriate training and infrastructure for data collection [18]. Whatever the amount of CFC available, the aim of a national or regional policy is to optimize care through equity in patients’ access to accurate diagnosis and appropriate care.